A descriptive cross-sectional study was conducted by a single calibrated examiner. Prior to data collection, intra-examiner reliability was assessed through the re-examination of 10 patients on two separate occasions. The study aimed to evaluate oral health among pregnant women attending urban health centers in the district of Ain Sebaâ-Hay Mohammadi in Casablanca, Morocco. Data collection took place between April and June 2025, corresponding to the period allocated for completing the fieldwork phase.

The calculation of the sample size was carried out using Epi-Info software. As we did not have Moroccan statistical data on the subject, we opted for an expected percentage of 50%. So, we used the formula to calculate the sample size by taking an α precision of 7%.

p being unknown in our country, we are going to work with p = 0.5.α = 7%.ε = 1.96.

With an increase of 10% to improve accuracy, which gave us a sample of about 200 pregnant women. Afterwards, we conducted a random draw of three health centers: Beausite, Derb Moulay Cherif and Hay Jamal (representing the three municipalities of the prefecture: Ain Sebaâ, Hay Mohammadi and Roches Noires) from among the 14 health centers present in the prefecture. We excluded from our study pregnant women under the age of 18 and those who had refused to participate.

The questionnaire was developed based on items previously used in the literature by Vergnes et al. [3], with adaptations to the Moroccan context, and served as the primary data collection tool. It comprised three sections: the first addressed the sociodemographic characteristics of the participants; the second assessed dietary habits and oral hygiene practices; and the third focused on oral health status and perceptions. Informed consent was obtained from all participants prior to data collection, following an explanation of the study objectives and assurance of anonymity. The questionnaire was pre-tested with 10 women.

The clinical examination was performed in well-lit rooms in daylight, using a sterile mirror and Dental explorer 6 and 17. The third molars were not examined. And X-rays were not taken.

Dental caries using the Decayed, Filled and Missing Tooth Index and Indices (DMFT) in accordance with World Health Organization criteria [5] for the diagnosis of dental caries. The periodontal state using the gingival index of Löe and Silness 1963 (Score 0: Normal gingiva, score 1: Mild inflammation, score 2: Moderate inflammation, score 3: Severe inflammation) [6].

An authorization has been obtained from the National School of Public Health. And all the women who agreed to participate in the study after explanation of its objectives were included in the study. Finally, our research was conducted in full compliance with the World Medical Association’s Declaration of Helsinki, https://www.wma.net/what-we-do/medical-ethics/declaration-of-helsinki/.

Each participant provided informed consent prior to enrolment, having been fully informed of the study objectives and assured that all responses would remain strictly anonymous. To preserve confidentiality, every participant was assigned a unique identification number, and no questionnaire contained personally identifiable information such as name, surname, or home address. Women who declined participation were reassured that their decision would not affect the medical follow-up of their pregnancy at the health centre.

All questionnaire data were recorded and compiled in a Microsoft Excel spreadsheet. Data processing was performed using Jamovi version 2.3.28. Descriptive statistics were applied to summarise the data: qualitative variables were expressed as frequencies and proportions, while quantitative variables were presented as means and standard deviations. Bivariate analyses were conducted using the chi-square test or Fisher’s exact test to examine associations between the presence of caries and the variables studied. A p-value of less than 0.05 was considered statistically significant.

A total of 200 women were enrolled in our study, all recruited from three selected urban health centers. Among them, 115 women (57.5%) had received prenatal care at Beausite center during the study period. Regarding nationality, the majority of participants were Moroccan (80.5%), while 39 women (19.5%) were of sub-Saharan origin.

The mean age of participants was 30.1 years ± 5.88, with ages ranging from 19 to 44 years. The most represented age group was 25 to 35 years, accounting for 59.5% of the sample. Most women were married (75%) and 66% identified as housewives. In terms of education, 56% had completed primary or middle school.

When asked about the importance of oral health during pregnancy: 66.3% of the women reported that they did not know whether it was important or not.

In response to the question, “Have you received any information on this topic?”, 98.5% of participants stated they had never received any information. Only one woman reported being informed by a healthcare professional, while two others mentioned obtaining information via the Internet.

When questioned about the possibility of receiving dental care during pregnancy, 80% of the women believed it was not feasible, while 20% thought that dental treatment should be postponed until after childbirth—even in cases of emergency.

Fifty-one percent of the participants acknowledged an increased consumption of sugary foods during pregnancy.

Regarding oral hygiene practices, 41.5% of the women reported brushing their teeth twice a day.

Regarding the visit to the dentist: 69.5% of pregnant women consult the dentist only in case of oral emergency.

Table 1. Profile of pregnant women attending urban health centers of district Ain-Sebaa Hay Mohammadi.

Table 2. Perception regarding oral health among pregnant women attending urban health centers of district Ain-Sebaa Hay Mohammadi.

Table 3. Dietary habits and oral practices during pregnancy.

Among the 200 women included in the study 73.5% had at least one decayed tooth, while 81% of participants presented with dental caries, defined as a DMFT index ≥ 1.

The mean DMFT (Decayed, Missing, and Filled Teeth) index in the study population was 6.30 ± 5.42, with a median of 6, ranging from 0 to 25.

In total, 665 decayed teeth, 345 missing teeth, and 250 filled teeth were recorded. Of all teeth examined, 53% were decayed, 27% were filled, and 20% were missing due to caries.

No case of pregnacy epulis was noted in our sample.

The average gingival index in our sample was 1.60 ± 0.66 and the median is 2.

The results of our study showed that the gingival index is 2 to 3 in 54.5% of the studied population with a middle to high level of gingival inflammation, and that 43.5% of women had mild inflammation, while only 2% of our population had normal gingiva.

Table 4. Bivariate analysis.

Sociodemographic analysis revealed multiple statistically significant associations with oral health outcomes. Nationality was significantly associated with both caries (p < 0.001) and gingivitis (p < 0.001): Moroccan women exhibited substantially higher caries rates (75% vs 9.5%) and gingivitis (50% vs 4.5%). While socioeconomic status was not significantly linked to caries (p = 0.35), it was meaningfully associated with gingivitis (p = 0.003), with women of low socioeconomic status bearing the greatest periodontal disease burden (67%). Regarding marital status caries prevalence was influenced (p = 0.004) but not gingivitis (p = 0.31), with married women accounting for the highest number of caries-positive cases (64%). Occupational status also proved significant, as housewives demonstrated elevated rates of both caries and gingivitis (p = 0.007). Oral hygiene practices emerged as a key modifiable factor, with toothbrushing frequency significantly associated with both caries (p = 0.039) and gingivitis (p < 0.001); women brushing fewer than twice daily consistently presented a higher disease burden across both conditions. Finally, dental attendance patterns were significantly associated with oral health status: both caries (p < 0.001) and gingivitis (p = 0.006) were most prevalent among women who had never visited a dentist or whose last visit exceeded 12 months.

This study has several limitations that should be taken into account when interpreting the findings. First, the cross-sectional design does not permit the establishment of causal relationships between the identified risk factors and oral health outcomes. Second, behavioural data (toothbrushing frequency, dietary habits, dental attendance) were self-reported and therefore subject to social desirability bias, which may have led to an overestimation of healthy behaviours. Third, recruitment was restricted to public primary healthcare facilities, which may not be representative of the overall pregnant population in Morocco, as women attending private facilities or those not seeking antenatal care were excluded. Finally, the DMFT index was calculated in accordance with WHO diagnostic criteria; however, the detection of proximal carious lesions requires radiographic examinations, which could not be performed in this study due to the pregnancy status of the participants.